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Linked-color imaging improves endoscopic visibility of colorectal nongranular flat lesions.

Suzuki T, Hara T etc

Gastrointest Endosc. 2017 Feb 10. pii: S0016-5107(17)30088-3. Impact factor 5.369

Background and Aims: As a newly developed image-enhanced endoscopy (IEE) technique, linked-color imaging (LCI) provides very bright images with enhanced color tones. With the objective of improving the detection rate of colorectal flat tumor lesions, which are difficult to detect, we examined the usefulness of LCI from the viewpoint of visibility.

Methods: Fifty-three consecutive nongranular flat tumors were used in this study. Endoscopic images were acquired by white-light imaging (WLI), blue-laser imaging (BLI)-bright, and LCI modes. For each lesion, we selected one image each acquired by WLI, BLI-bright, and LCI modes. Six endoscopists interpreted the images. Using a previously reported visibility scale, we scored the visibility level on a scale of 1 to 4.

Results: The mean visibility scores were 2.74 ± 1.08 for WLI, 2.94 ± 0.97 for BLI-bright, and 3.36 ± 0.72 for LCI. The score was significantly higher for BLI-bright compared with WLI (p<0.001), and again higher for LCI compared with BLI-bright (p<0.001). When comparing between experts and trainees, the corresponding scores of experts were 2.83 ± 1.06, 3.17 ± 0.88, and 3.40 ± 0.74, with a tendency similar to the scores of all endoscopists. For the trainees, there was no difference between the scores for WLI (2.65 ± 1.10) and BLI-bright (2.71 ± 1.00), but the score for LCI (3.31 ± 0.69) was significantly higher than that for WLI or BLI-bright (p<0.001). When only sessile serrated adenoma/polyp (SSA/P) lesions were analyzed, LCI remained significantly higher than the other two.

Conclusions: The present findings suggest that LCI increases the visibility of colorectal flat lesions and contributes to improve the detection rate of these lesions.


Detectability of colorectal neoplastic lesions using a novel endoscopic system with blue laser imaging: a multicenter randomized controlled trial.

Ikematsu H, Sakamoto T

Gastrointest Endosc. 2017 Jan 29. Impact factor 5.369

Background and Aims: Most studies have not reported an improvement in the detection of adenomas with the use of image-enhanced colonoscopy methods, possibly because of the darkness of the images. To overcome this limitation, a new-generation endoscopic system has been developed. This system has 2 blue-laser imaging (BLI) observation modes. The BLI observation was set to BLI-bright mode to detect lesions. We aimed to evaluate the efficacy of BLI in detecting lesions.

Methods: This study was designed as a randomized controlled trial with participants from 8 institutions. We enrolled patients aged ≥40 years. The participants were randomly assigned to 2 groups: observation by using white-light imaging (WLI) with a conventional xenon light source (WLI group) or observation by using BLI-bright mode with a laser light source (BLI group). All of the detected lesions were resected or had a biopsy taken for histopathologic analysis. The primary outcome was the mean number of adenomas per patient (MAP) that were detected per procedure.

Results: The WLI and BLI groups consisted of 474 and 489 patients, respectively. The MAP was significantly higher in the BLI group than in the WLI group (mean ± standard deviation [SD] WLI 1.01 ± 1.36, BLI 1.27 ± 1.73; P = .008). Adenoma detection rate in the BLI group was not significantly higher than in the WLI group. Observation times differed significantly, with BLI (9.48 minutes) being longer than WLI (8.42; P < .001). The mean (± SD) number of polyps per patient was significantly higher in the BLI group compared with the WLI group (WLI 1.43 ± 1.64, BLI 1.84 ± 2.09; P = .001).

Conclusions: A newly developed system that uses BLI improves the detection of adenomatous lesions compared with WLI.


Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett’s Esophagus.

Iwashita C, Miura Y

Clin Endosc. 2017 Jan;50(1): Impact factor 0.94

Abstract: Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.


Clinical Usefulness of the VS Classification System Using Magnifying Endoscopy with Blue Laser Imaging for Early Gastric Cancer

Yoshikazu Yoshifuku,1 Yoji Sanomura,2 Shiro Oka,1 Kazutaka Kuroki,1 Mio Kurihara,Takeshi Mizumoto,1 Yuji Urabe,1 Toru Hiyama,3 Shinji Tanaka,2 and Kazuaki Chayama1

Gastroenterology Research and Practice Volume 2017, Article ID 3649705, 6 pages

Background: Blue laser imaging (BLI) enables the acquisition of more information from tumors’ surfaces compared with white light imaging. Few reports confirm the validity of magnifying endoscopy (ME) with BLI (ME-BLI) for early gastric cancer (EGC). We aimed to assess the detailed endoscopic findings from EGCs using ME-BLI.

Methods: We enrolled 386 consecutive patients with 417 EGCs that were diagnosed using ME-BLI and resected by endoscopic submucosal dissection. Using the VS classification system, three highly experienced endoscopists (HEEs) and three less experienced endoscopists (LEEs) evaluated the demarcation line (DL), microsurface pattern (MSP), and microvascular pattern (MVP) within the endoscopic images of EGCs obtained using ME-BLI, assigning high-confidence (HC) or low-confidence (LC) levels. We investigated the clinicopathological features associated with each confidence level.

Results: The HEEs’ evaluations determined the presence of DL in 99%, irregular MSP in 96%, and irregular MVP in 96%, and the LEEs’ evaluations determined the presence of DL in 98%, irregular MSP in 95%, and irregular MVP in 95% of the EGCs. When DL was present, HC levels in the Helicobacter pylori- (H. pylori-) eradicated group and noneradicated group were evident in 65% and 89%, a difference that was significant (p < 0 001).

Conclusions: In the diagnosis of EGC with ME-BLI, the VS classification system with ME-NBI can be applied, but identifying the DL after H. pylori was difficult.


Blue Laser Imaging-Bright Improves Endoscopic Recognition of Superficial Esophageal Squamous Cell Carcinoma.

Tomie A, Dohi O

Gastroenterol Res Pract. 2016;2016:6140854. Epub 2016 Sep 22. Impact factor 1.742

Abstract: The aim of this study was to evaluate the endoscopic recognition of esophageal squamous cell carcinoma (ESCC) using four different methods (Olympus white light imaging (O-WLI), Fujifilm white light imaging (F-WLI), narrow band imaging (NBI), and blue laser imaging- (BLI-) bright). Methods. We retrospectively analyzed 25 superficial ESCCs that had been examined using the four different methods. Subjective evaluation was provided by three endoscopists as a ranking score (RS) of each image based on the ease of detection of the cancerous area. For the objective evaluation we calculated the color difference scores (CDS) between the cancerous and noncancerous areas with each of the four methods.

Results: There was no difference between the mean RS of O-WLI and F-WLI. The mean RS of NBI was significantly higher than that of O-WLI and that of BLI-bright was significantly higher than that of F-WLI. Moreover, the mean RS of BLI-bright was significantly higher than that of NBI. Furthermore, in the objective evaluation, the mean CDS of BLI-bright was significantly higher than that of O-WLI, F-WLI, and NBI.

Conclusion: The recognition of superficial ESCC using BLI-bright was more efficacious than the other methods tested both subjectively and objectively.


Linked color imaging application for improving the endoscopic diagnosis accuracy: a pilot study.

Sun X, Dong T

Sci Rep. 2016 Sep 19; Impact factor 5.228

Abstract: Endoscopy has been widely used in diagnosing gastrointestinal mucosal lesions. However, there are still lack of objective endoscopic criteria. Linked color imaging (LCI) is newly developed endoscopic technique which enhances color contrast. Thus, we investigated the clinical application of LCI and further analyzed pixel brightness for RGB color model. All the lesions were observed by white light endoscopy (WLE), LCI and blue laser imaging (BLI). Matlab software was used to calculate pixel brightness for red (R), green (G) and blue color (B). Of the endoscopic images for lesions, LCI had significantly higher R compared with BLI but higher G compared with WLE (all P < 0.05). R/(G + B) was significantly different among 3 techniques and qualified as a composite LCI marker. Our correlation analysis of endoscopic diagnosis with pathology revealed that LCI was quite consistent with pathological diagnosis (P = 0.000) and the color could predict certain kinds of lesions. ROC curve demonstrated at the cutoff of R/(G+B) = 0.646, the area under curve was 0.646, and the sensitivity and specificity was 0.514 and 0.773. Taken together, LCI could improve efficiency and accuracy of diagnosing gastrointestinal mucosal lesions and benefit target biopsy. R/(G + B) based on pixel brightness may be introduced as a objective criterion for evaluating endoscopic images.


Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection.

Dohi O1, Yagi N1, etc

Endosc Int Open. 2016 Jul;4(7): Impact factor 5.196

Background and Study Aims: Linked color imaging (LCI) is a new image-enhanced endoscopy technique using a laser light source to enhance slight differences in mucosal color. The aim of this study was to compare the usefulness of LCI and conventional white light imaging (WLI) endoscopy for diagnosing Helicobacter pylori (H. pylori).

Patients and Methods: We retrospectively analyzed images from 60 patients examined with WLI and LCI endoscopy between October 2013 and May 2014. Thirty patients had H. pylori infections, and other thirty patients tested negative for H. pylori after eradication therapy. Four endoscopists evaluated the 2 types of images to determine which was better at facilitating a diagnosis of H. pylori infection.

Results: H. pylori infection was identified with LCI by enhancing the red appearance of the fundic gland mucosa. The accuracy, sensitivity, and specificity for diagnosing H. pylori infection using WLI were 74.2 %, 81.7 %, and 66.7 %, respectively, while those for LCI were 85.8 %, 93.3 %, and 78.3 %, respectively. Thus, the accuracy and sensitivity for LCI were significantly higher than those for WLI (P = 0.002 and P = 0.011, respectively). The kappa values for the inter- and intraobserver variability among the 4 endoscopists were higher for LCI than for WLI.

Conclusion: H. pylori infection can be identified by enhancing endoscopic images of the diffuse redness of the fundic gland using LCI. LCI is a novel image-enhanced endoscopy and is more useful for diagnosing H. pylori infection than is WLI.


Laterally Spreading Tumor of the Rectum Delineated with Linked Color Imaging Technology

Masahiro O, Hirotsugu S, etc

Clin Endosc. 2016 Mar; 49(2) Impact factor 0.94

A 66-year-old woman with a 40-mm laterally spreading tumor of the rectum was referred for endoscopic resection. Before the endoscopic resection, we observed the lesion with an EC-L590ZW endoscope with the LASEREO system (FUJIFILM Co., Tokyo, Japan), with white light (Fig. 1A) and with Linked Color Imaging (LCI) (Fig. 1B). The lesion was clearly seen as a bright reddish area on LCI. Compared with the white light image, the LCI image makes the lesion more easily recognizable, thanks to the striking color contrast between the neoplastic mucosa and the normal mucosa. The lesion was diagnosed as an adenoma on the basis of the magnified BLI images. Successful en bloc endoscopic submucosal dissection was performed for the lesion, and the diagnosis of high-grade adenoma with negative resection margins was confirmed histopathologically.

LCI may facilitate the detection of flat colorectal neoplasms without magnification. After the detection of lesions, BLI images are easily produced with a push of a button for use in qualitative diagnosis. Further studies are needed to confirm the utility of LCI.


Magnified endoscopic observation of early colorectal cancer by linked color imaging with crystal violet staining (with video).

Suzuki T1, Hara T1

Gastrointest Endosc. 2016 Oct;84(4): Impact factor 5.369

Background and Aims: Many reports have shown the usefulness of magnification endoscopy with crystal violet (CV) staining for delineating the pit pattern in the diagnosis of colorectal carcinoma. However, the diagnostic accuracy of this method is not adequate for assessing the depth of invasion of early stage cancers. The novel technology of linked color imaging (LCI) combined with CV staining is expected to improve the accuracy of determining the depth of invasion.

Methods: We studied 3 patients with early stage colorectal cancer who were referred to our hospital. After CV spraying, high-magnification endoscopy was conducted by using the LCI mode. Efficacy of this modality was evaluated by comparing the preoperative diagnostic endoscopic images with posttreatment histopathologic findings.

Results: In 2 cases of rectal cancer, although conventional endoscopic examination could not exclude the possibility of submucosal cancer, use of the LCI mode with CV staining confirmed mucosal cancer. Eventually, EMR was conducted and achieved curative resection. In 1 case of sigmoid colon cancer, both conventional and CV magnification endoscopy suggested submucosal cancer. However, mucosal cancer was diagnosed by the novel method, and EMR achieved curative resection.

Conclusions: LCI high-magnification endoscopy combined with CV staining provides images close to histopathologic findings and is expected to improve the accuracy of endoscopic diagnosis of the depth of invasion for early stage colorectal cancer.


Blue laser imaging endoscopy system for the early detection and characterization of colorectal lesions: a guide for the endoscopist.

Togashi K, Nemoto D etc

Therap Adv Gastroenterol. 2016 Jan;9(1): Impact factor 3.883

Abstract: Blue laser imaging is a new system for image-enhanced endoscopy using laser light. Blue laser imaging utilizes two monochromatic lasers (410 and 450 nm) instead of xenon light. A 410 nm laser visualizes vascular microarchitecture, similar to narrow band imaging, and a 450 nm laser provides white light by excitation. According to three recently published reports, the diagnostic ability of polyp characterization using blue laser imaging compares favorably with narrow band imaging. No published data are available to date regarding polyp detection with blue laser imaging. However, blue laser imaging has the possibility to increase the detection of colorectal polyps by depicting brighter and clearer endoscopic images, even at a distant view, compared with first-generation image-enhanced endoscopy. A clinical trial to compare the detection between blue laser imaging and xenon light is warranted.